RTE's 'Operation Transformation' does a tremendous amount of good in raising awareness of overweight and obesity. The ratings speak for themselves and the level of public engagement and participation in their community-based initiatives is impressive and undoubtedly beneficial. The addition of a dietitian and a GP to the expert panel has enhanced significantly the quality of the clinical advice now given to the show's participants.
However, aspects of the show diminish it and may even be counterproductive and harmful. Firstly, interactions with the "leaders" sometimes seem humiliating. There is a pervading sense that a person's moral strength, work ethic, intelligence and overall contribution to society are proportional to how much excess fat they carry. This stigmatises obesity and reinforces negative stereotypes about obese people. A few weeks ago, participants on the show were chastised by a fireman for being harder to rescue than if they were thin. Their fatness was a moral failure, a selfish lack of discipline and self-control and a burden on the fire service and on society. This will undoubtedly have caused distress to some people affected by obesity. Also, the willing acceptance of humiliation as part of a weight loss process by participants who volunteer for the show should not justify that humiliation. Of course, overweight and obese people need to eat healthier and be more physically active, but shouting at them for being too fat just doesn't work.
We don't humiliate people with traumatic brain injury after drink driving, or HIV after unprotected sex, yet we are uniquely intolerant and judgemental of the fatness that arises from the folly of overeating. Little is made of the scientific certainty that some people find it much harder than others to avoid being fat and that changes in our environment have driven the obesity epidemic, not changes in how responsible we all are. Rather than seeing obesity simply as a burden on society caused by the gluttony and sloth of irresponsible individuals, it might serve us well to see it as a burden on affected individuals caused by societal and corporate greed. By blaming fat people for the obesity epidemic, 'Operation Transformation' perpetuates a political and legislative status quo, whereby well-resourced multinational corporations seem to have a disproportionate influence on policy and nothing is done to address the environmental factors driving obesity in Ireland. While on the one hand it is important to engage in constructive dialogue with food retailers and other stakeholders, it was ironic to see a large supermarket chain being congratulated for playing a responsible part in dealing with the problem, while the show's leaders were berated for contributing to it. Many authorities in the field would consider that 'Operation Transformation' has this approach the wrong way around.
In having her knuckles rapped for criticising the show recently, Dr Jacky Jones (a health promotion expert) no doubt knows what Voltaire meant when he said that "it is dangerous to be right in matters on which the established authorities are wrong". Her assertion that we need to focus on the environmental determinants of obesity is spot on. Rather than scrutinising the show's leaders, we should scrutinise their communities. We should examine what we feed our children and what we tell their parents. We should consider the width of our cycle lanes and the cost of our crisps. RTE states that its "campaigns are designed to counter teenage obesity by promoting physical activity in schools", yet then allows the advertising of chocolate cereals to parents with pseudoscientific insinuations that they are somehow a healthy option for breakfast! Taking a broader perspective on RTE's handling of the issue of obesity, much is left to be desired. A guest on 'The Late Late Show' last week proudly proclaimed that she "hates fat people", which she is entitled to do. Of concern, though was the contrived nature of the insult and the interview. This wasn't an unanticipated outburst from an unpredictable guest. It was planned and provoked, with footage of previous humiliation of obese people ready to roll, just for good measure. The silence from an otherwise convivial audience on the night was symptomatic of how patronising, offensive and out of touch RTE can be on this issue. It was disgraceful.
Reflecting on Ireland's major achievements in public health campaigns such as the smoking ban or pending legislation for the minimal pricing of alcohol, it is clear that they have come about through the translation of robust, unbiased and coherent (if inconspicuous) scientific reason into pragmatic, proportionate policy. The implementation of such policies is led by politicians and legislators, not entertainers. The level of pseudo-expert commentary and "noise" around the obesity issue in Ireland is unprecedented and may be stifling effective policy development. Trite rhetoric about how ashamed we should be as a nation of our obesity levels (which are about as bad as they are in other countries) appeals to the masses but perpetuates a disjointed, inadequate response to the problem. We should be ashamed of what school children buy for lunch. As it stands, if obesity was a flood, we'd ask people to swim harder.
Hopefully, future iterations of 'Operation Transformation' will continue to evolve and explore some of the environmental determinants of obesity and how we might address these. It would be good to see the leaders being treated with more dignity and respect, even if they know in advance what they are signing up for. At the very least, they could put some light, loose-fitting indoor clothes on during televised weigh-ins.
Dr Francis Finucane is a Consultant Endocrinologist at Galway University Hospital